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Full text of "Cancer Incidence and Mortality Along the Texas-Mexico Border"

Cancer Incidence & Mortality 

along the 

Texas-Mexico Border 



L^IIIIJ 



Office of Minority Health 

Resource Center 

PO Box 37337 

Washington, DC 2u01 3-7337 



Texas Department of Health 
August 1996 



X 


© 




00 avid R. Smith, M.D. IMS! Walter D. Wilkerson, Jr, M.D., Chairman 

ommissioner of Health n -1 rvTJ Board of Health 



This publication was prepared by: 

Texas Cancer Registry 
Texas Department of Health 
1100 West 49th Street 
Austin, TX 78756 
(512)502-0680 



Funding: 

This publication is made possible in part by funding from the Texas Department of Health, Office 
of Border Health. 



Acknowledgments : 

This report is a product of the efforts of the entire Registry staff. The Registry wishes to thank 
the health facilities located along the Texas-Mexico border for their cooperation in reporting 
cancer incidence for their areas. 



Suggested citation: 

Texas Cancer Registry. Cancer Incidence and Mortality Along the Texas-Mexico Border. 
Austin, Texas: Texas Department of Health, August, 1996. 



Copyright information: 

All material in this report is in the public domain and may be reproduced or copied without 
permission; citation as to source, however, is appreciated. 



AVH^D^gg' 




Texas Department of Health 



David R. Smith, M.D. 
Commissioner 

Carol S. Daniels 

Deputy Commissioner for Programs 

Roy L. Hogan 

Deputy Commissioner for Administration 

Randy P. Washington 
Deputy Commissioner 
for Health Care Financing 



1100 West 49th Street 

Austin, Texas 78756-3199 

(512) 458-7111 



MEMBERS OF THE BOARD 

Walter D. Wilkerson, Jr., M.D., Chairman 

Mary E. Ceverha,M.R A., Vice-Chair 

Ramiro R. Casso, M.D. 

David L. Collins, P.E. 

Ruth F. Stewart, M.S., R.N.C. 

Betsy Triplett-Hurt 



FOREWORD 



The Rio Grande River winds through an area of Texas unique in its culture, geography, economy, 
and problems. The Texas-Mexico border area is not only a geo-political boundary, but also a place 
where the peoples of two cultures, two languages, and two different levels of economic 
development meet and interact. The population of the border area has exploded in the past 20 
years — almost 1.9 million people are expected to live on the Texas side of the border region by 
the year 2000. Unfortunately, it is a population characterized by high rates of poverty and disease. 

The health of these border residents is a continuing priority of the Texas Department of Health. 
In 1994, the Department created the Office of Border Health to assist with the improvement of 
health conditions in this population. The Border Health Office has encouraged collaborative efforts 
with other Divisions within the Department to address specific border health issues. This study 
by the Texas Cancer Registry is a product of one such collaboration undertaken to describe the 
cancer experience of this unique region of Texas. 

This is the first report to present cancer incidence and mortality data specifically for the Texas- 
Mexico border area population. These data give a solid basis for development of targeted 
interventions by the Texas Department of Health and other state, national and international 
agencies working for and with the border residents to improve the quality of life and health for 
Texans living in this area. Continued collection and analysis of cancer data will allow the Texas 
Department of Health to evaluate the success of cancer control interventions, to identify and 
monitor those subgroups at highest risk, and to investigate suspected clusters of excess cancer in 
this area. This joint effort by the Texas Cancer Registry and the Border Health Office underscores 
the continuing commitment within the Texas Department of Health to identify and address the 
unique public health issues and concerns facing Texas residents living along the Texas-Mexico 
border. 



y(^^^^/f^ ^\V^?^\i 



David R. Smith, M.D. 
Commissioner of Health 



Walter D. Wilkerson, Jr., M.D., 
Board of Health 




An Equal Employment Opportunity Employer 



Executive Summary 



The unique character of the Texas-Mexico border area has led to much interest, speculation and concern 
about the health status of the residents of this area in general, and their cancer experience in particular. 
So it is encouraging to note in this report by the Texas Cancer Registry (TCR), Texas Department of 
Health, that while the border area is unique in many demographic and geographic characteristics, its 
cancer experience is not greatly different than that experienced elsewhere. The border area had an 
average of approximately 2.8 cancer cases per 1,000 residents reported annually, a rate that is slightly 
lower than the national average. When comparing the border data to California data, a population with 
similar racial and ethnic composition, the TCR found that the type and magnitude of cancer cases and 
deaths reported for this area are, in general, similar to or lower than those of the comparison population. 

As with most areas of the United States, prostate cancer was the most common form of cancer 
diagnosed in border males and breast cancer the most common in females. Lung cancer, a type of cancer 
with poor survival, was a leading cause of cancer-related death in both males and females. Among 
children living in the border area, the leading types of cancers diagnosed were leukemics and central 
nervous system tumors, the cancer sites typically predominant in children. 

Perhaps the most interesting finding in this study is the differing pattern of cancer incidence and mortality 
among Anglos and Hispanics. This analysis found that for most cancer sites, Hispanics experience 
substantially lower rates of cancer incidence, a finding consistent with several studies in other 
populations. For example, although prostate cancer was the most common cancer diagnosed in both 
Anglo and Hispanic men, the incidence rate for Hispanics was 74% less than that of Anglos. The same 
pattern was seen among women in the border, with Anglo females having a breast cancer incidence rate 
1.5 times higher than that of Hispanic females. 

There were, however, notable exceptions to the lower levels of cancer in Hispanics as compared to 
Anglos. Hispanic women had a statistically significant two-fold greater rate of cervical cancer incidence 
and mortality than Anglo women. Because cervical cancer is one of the few cancers that is amenable 
to prevention through screening, this finding underscores the need for targeted Pap screening efforts. 
Another troubling exception was found in the prostate cancer data. Despite the much higher incidence 
rate of prostate cancer in Anglo males, the mortality rate for this cancer was approximately equal in men 
of both race/ethnic groups. This may indicate either a problem with access to medical care among 
Hispanic males, or that more cases in Hispanics are diagnosed at a late stage, resulting in poorer survival. 
Both of these examples indicate that while the overall cancer experience of the border area compares 
favorably to other U.S. populations, there is still the potential to reduce cancer incidence and mortality 
for this population. With data such as these provided by the TCR, the Texas Department of Health and 
its partners in public health can further the work towards clarifying and addressing cancer prevention and 
control issues along the Texas-Mexico border. 



Table of Contents 



Introduction 1 

Methods 1 

Results 2 

Discussion 8 

Technical Notes 14 

Literature Cited 20 

Appendices 23 

Appendix I. Tables. 

Table 1 . Number of cancer cases and average annual 
age-adjusted incidence rates by sex and 
race/ethnicity 24 

Table 2. Number of cancer deaths and average annual 
age-adjusted mortality rates by sex and 
race/ethnicity 26 

Table 3 . Comparison of Texas-Mexico border area incidence ( 1 990- 1 992) 
and mortality (1990-1993) rates with California 
rates (1988-1992) 28 

Appendix II. Percent of Cancer Cases Microscopically 

Confirmed and Percent of Death Certificate 

Only Cases 30 

Appendix III. International Classification of Diseases for 
Oncology (ICD-O) Categories Used to 
Classify Primary Site 31 

Appendix IV. Ninth Revision ICD Mortality Categories Used 

to Classify Primary Site 33 

Appendix V. Population Estimates 35 



in 



Cancer Incidence and Mortality Along the Texas-Mexico Border 



INTRODUCTION 



Figure 1 

TEXAS-MEXICO BORDER 

AREA 




METHODS 

BORDER COUNTIES 

Brewster 

Cameron 

Culberson 

Dimmit 

El Paso 

Hidalgo 

Hudspedth 

Jeff Davis 

Kinney 

Maverick 

Presidio 

Starr 

Terrell 

Val Verde 

Webb 

Willacy 

Zapata 

Zavala 



The border region is a unique area of Texas, with a culture, geog- 
raphy and economy distinct from the rest of the state. The area 
stretches 889 miles from El Paso to Brownsville and is charac- 
terized by a rapidly growing population that is on the average younger 
and poorer than the rest of Texas. The Texas Department of Health 
(TDH) has made identifying and addressing health and quality of life 
issues for residents of the border area a priority. As a part of this 
initiative, the Texas Cancer Registry (TCR) of the Texas Department 
of Health, with funding from the TDH Office of Border Health, con- 
ducted a study of the cancer incidence and mortality experience of 
Texans living along the Texas-Mexico border. The following report 
presents the results of this study. 



An 1 8-county area along the Texas-Mexico border was defined 
for the purposes of this study (Figure 1). In 1990, the popula- 
tion of this area was approximately 1 .6 million, almost 80% of 
whom were Hispanic. African Americans accounted for less than two 
percent of the total study population (Figure 2). There were roughly 
equal numbers of males to females overall in each of the racial/ethnic 
groups. 

Figure 2 

TEXAS-MEXICO BORDER AREA POPULATION, 1990 



Anglo 
(19.4%) 

Hispanic 1 H African 

(79.1%) J American 

(1.5%) 




BORDER AREA CANCER 

STATISTICS 

1990-1993 

Average number 

of cancer cases 

diagnosed each year*: 4,356 1 

Average number 
of cancer deaths 
reported each year: 1 ,936 2 

*1 990-1 992 

1 2.8 cancer cases per 1 ,000 

residents 

2 1 .2 deaths per 1 ,000 residents 



RESULTS 



Figure 3 

RATES OF TOTAL CANCERS 

Males and Females, 1990-1993 



350- 

300- 


n 


■ 

□ 


Males 
Females 












250- 


■ 






200- 








150- 


■ 


i 


■ 




100- 


■ 




50- 


■ 


i 


1 

















The data analyzed consist of cancer cases diagnosed during 1 990-1992 
("incidence") and cancer-related deaths occurring during 1990-1993 
("mortality") among residents of the study area. All incident reports of 
cancer were reviewed to eliminate inclusion of multiple reports for a 
single case and to determine primary cancer sites. The number of can- 
cer cases and deaths among African Americans in the border area was 
too small to generate stable statistics, consequently this report pre- 
sents data only for Anglo (white, non-Hispanic) and Hispanic males 
and females. 

Average annual number of cases or deaths and average annual rates are 
presented by race/ethnicity and sex for individual cancer sites. Rates 
were standardized by age with the direct method of adjustment, using 
the US 1 970 standard million population, and are presented per 1 00,000 
population (see Technical Notes). The TDH Bureau of State Health 
Data and Policy Analysis provided age-, sex-, race/ethnicity-, county- 
and year-specific population estimates for the calculation of rates. To 
evaluate the cancer experience of the border area as compared to an 
external standard, border incidence and mortality rates were compared 
with rates for Anglo and Hispanic residents of California. California 
was chosen as a comparison population due to: 1) the lack of state- 
wide cancer incidence data for Texas; and 2) the lack of Hispanic rates 
for national cancer incidence data (see Technical Notes for detailed 
discussion of comparison methodology). 



During the study period, there was an average of 4,356 cancer 
cases and 1,936 cancer deaths reported annually for 
Anglo and Hispanic residents of the 1 8 counties of the Texas- 
Mexico border area (Appendix I, Tables 1 and 2 ). Hispanic incidence 
and mortality rates were lower than Anglo rates for most cancer sites, 
with the exception of stomach, liver, gallbladder, kidney (incidence 
only) and cervix. 

In general, males had higher age-adjusted cancer incidence and mor- 
tality rates than females (Figure 3). Gallbladder and thyroid cancers 
were the only cancer sites where females experienced both higher 
incidence and higher mortality rates than males (for those sites com- 
mon to both sexes). 



Incidence 



Mortality 



'For 1990-1992 only 



Figure 4 The age-specific incidence rates for Texans living in the border area 

AGE-SPECIFIC CANCER show that overall, cancer is rare among children, increases in young 

RATE adults and is highest among older adults (Figure 4). Eighty-six percent 

M 3 .'!! f ?? . F . en ?!'? f '. ! ^°.". 1 ??? . of a11 cases diagnosed in males occurred among men ages 5 5 and older, 

as compared with 7 1 % in women. As seen in Figure 5, breast cancer in 
young women is the primary reason that females have higher rates than 
males between the ages of 15 and 54. After age 55, male rates rapidly 
surpass female rates. Prostate cancer, a disease primarily of older men, 
is largely responsible for the almost two-fold difference in rates among 
males and females after age 75. 

Figure 5 

LEADING INCIDENT CANCERS BY AGE GROUP 

Males and Females, 1990-1992 

CANCER SITE RATE* 



PROSTATE 11814 



~ 1000 





LUNG 
COLON 



BREAST 

LUNG 

COLON 



457.8 
262.9 

220.2 
181.8 



Ages 
55-74 



PROSTATE 

LUNG 

COLON 



381.7 

255.7 

94.4 



BREAST 

LUNG 

COLON 



255.6 

105.0 

63.7 



Ages 
15-54 



ff 



TESTIS 6 5 

LUNG 54 

NON-HODGKIN S 54 



§, P 



BREAST 
CERVIX 
THYROID 



48.5 

16.4 

8.4 



Ages 

Under 

15 



LEUKEMIA 

BRAIN 

LYMPHOMA 



8.4 
3.3 
1.6 



1 



LEUKEMIA 

LYMPHOMA 

BRAIN 



6.7 
3.4 

1.2 



'Rate per 100,000 



Males 



Prostate cancer was the leading cancer incidence site in males, ac- 
counting for 28% of all cancer cases, and was second only to 
lung cancer for cancer mortality (Figure 6 ). Lung cancer ac- 
counted for 1 6% of cancer incidence and 27% of cancer mortality in 
males. Prostate, lung, colon and bladder cancers alone accounted for 
over half (56%) of all cancer cases in males. Similarly, the four leading 
cancer sites (lung, prostate, colon, pancreas) comprised 50% of all 
cancer-related deaths in males. 



LEADING SITES FOR 
CANCER CASES 
Males, 1990-1992 



* 



Figure 6 

LEADING CANCER SITES 

All Males 



INCIDENCE AND MORTALITY 



ANGLO 

Cancer 



# cases* rate 



Lung (16%) 



Prostate 

Lung 

Colon 

Bladder 

Buccal 



351 

198 

93 

64 

36 



133.7 
82.5 
37.8 
26.2 
17.3 



HISPANIC 

Cancer # cases* rate 



Prostate 

Lung 

Colon 

Stomach 

Kidney 



276 

162 

71 

51 

51 



76.7 
43.8 
18.7 
13.3 
12.9 



LEADING SITES FOR 
CANCER DEATHS 
Males, 1990-1993 



31.8 

18.0 

8.4 

5.8 

3.2 



%* 



24.1 

14.2 

6.2 

4.4 

4.4 



t 




Prostate 
(28%) 



Prostate (11%) Lung (27%) 

Colon 
(7%), 
Pancreas 
(5%) 



Other (44%) 

Incidence, 1990-1992 




Other (50%) 

Mortality, 1990-1993 



Cancer incidence and mortality varied by race/ethnicity among males, 
both in terms of ranking of cancer sites and comparative magnitude of 
rates 1 . Prostate cancer was the most common cancer diagnosed in 
both Anglo and Hispanic men. However, the incidence rate for His- 
panics (76.7 per 100,000) was 74% less than that of Anglos (133.7). 
Incidence rates for other leading cancer sites were also less among 
Hispanic males than Anglo males, with the exception of stomach, liver 
and kidney cancers (Appendix I, Table 1). 



ANGLO 

Cancer 



# deaths* rate 



Lung 


148 


60.4 


32.9 


Prostate 


53 


19.6 


11.8 


Colon 


39 


15.9 


8.7 


Pancreas 


24 


9.4 


5.2 


Leukemia 


21 


9.2 


4.7 


HISPANIC 








Cancer # deaths* 


rate 


%** 


Lung 


134 


36.1 


23.0 


Prostate 


65 


18.3 


11.2 


Stomach 


41 


10.6 


7.0 


Colon 


37 


9.6 


6.3 


Liver 


36 


9.4 


6.1 



Lung cancer was the leading site for mortality in both race/ethnic 
groups, with Hispanics experiencing a statistically significantly lower 
mortality rate (36.1) than Anglos (60.4). Prostate cancer was the 
second leading cause of cancer mortality in border males. Although 
Hispanic males had a statistically significantly lower incidence rate for 
prostate cancer than Anglo males, mortality rates for the two race/ 
ethnic groups were approximately equivalent (Anglo, 19.6; Hispanic, 
18.3). With the notable exception of stomach and liver cancers, the 
general pattern of lower rates among Hispanics seen in the leading 
cancer incidence sites was repeated in the mortality statistics (Appen- 
dix I, Table 2). 



'Average annual number of cases/deaths. 
**Percent of total cases/deaths. 



All rates are average annual age-adjusted rates and are reported 
per 100,000 population. 



LEADING SITES FOR 
CANCER CASES 
Females, 1990-1992 



ANGLO 

Cancer 



# cases* rate %* 



Breast 
Lung 
Colon 
Corpus 
uteri 
Ovary 



266 

117 

81 

42 
39 



114.0 
42.7 
28.0 

17.2 
16.8 



HISPANIC 

Cancer # cases* rate 



Breast 

Cervix 

Lung 

Colon 

Ovary 



LEADING SITES FOR 
CANCER DEATHS 
Females, 1990-1993 



31.3 

13.7 

9.5 

5.0 
4.6 



%* 



352 


65.2 


28.0 


108 


18.8 


8.6 


92 


18.1 


7.3 


69 


13.4 


5.5 


56 


10.3 


4.5 



Females 

Breast cancer was the leading cancer site for both incidence and mor- 
tality among females in this study, accounting for 29% of all cancer 
cases and 18% of all cancer deaths (Figure 7). Although lung cancers 
comprised only a tenth of the total reported cases, there were almost 
as many deaths due to this cancer as there were for breast cancer ( 1 7% 
vs. 18%). Seven percent of both cancer cases and cancer deaths among 
border women was attributable to colon cancer. The four leading can- 
cer sites for incidence (breast, lung, colon, cervix) and for mortality 
(breast, lung, colon, pancreas) accounted for approximately half of all 
reported cancer cases and deaths. 



Figure 7 

LEADING CANCER SITES 

All Females 



INCIDENCE AND MORTALITY 



Lung 
(10%) 




Breast 
(29%) 



Lung 
(17%) 



Other (48%) 
Incidence, 1990-1992 




Breast 
(18%) 



Other (52%) 

Mortality, 1990-1993 



ANGLO 

Cancer 



# deaths* rate 



Lung 


87 


30.3 


23.7 


Breast 


64 


25.6 


17.3 


Colon 


35 


12.4 


9.6 


Ovary 


22 


8.8 


6.0 


Leukemia 


15 


6.2 


4.2 


HISPANIC 








Cancer # deaths* 


rate 


%** 


Breast 


95 


17.3 


17.7 


Lung 


64 


12.3 


11.9 


Pancreas 


35 


6.8 


6.4 


Stomach 


31 


5.8 


5.7 


Ovary 


30 


5.8 


5.6 



'Average annual number of cases/deaths. 
**Percent of total cases/deaths. 



Cancer incidence and mortality differed among Hispanic and Anglo 
women in this study. As with the males, Hispanic women generally 
had lower incidence and mortality rates than their Anglo counterparts 
(Appendix I, Tables 1 and 2). Among the leading cancer sites, Anglo 
women had at least twice the incidence and mortality rates for lung and 
colon cancers than Hispanic women, and 1.5 times or higher rates for 
breast and ovarian cancers. This pattern is reversed with cervical can- 
cer, however, with Hispanic females experiencing a statistically signifi- 
cant two-fold greater rate than Anglo females for both incidence (18.8 
vs. 9.4) and mortality (5.7 vs. 2.9). Hispanic females also had approxi- 
mately double the incidence (7.6 vs. 3.5) and mortality (5.8 vs. 2.5) 
rates of Anglo women for stomach cancer ~ mirroring the pattern seen 
for males in the border area. Additionally, Hispanic females experi- 
enced two- to four-fold greater incidence and mortality for liver and 
gallbladder cancer as compared to Anglo females. 



Figure 8 

LEADING CHILDHOOD 

CANCERS 

Males and Females, 1990-1 992 



LEUKEMIA 
(46%; N=34*) 



BONE 
(6%; N=4*) 



LYMPHOMA 
(8%; N=6*) 




CENTRAL 
NERVOUS 
SYSTEM 
(15%; N=12*) 



OTHER 
(25%; N=19* 



Childhood cancer 

T I here were approximately 75 cancer cases and 21 cancer deaths 
reported annually in children under the age of fifteen residing in 
the study area. Slightly more cases and deaths were reported 
among male than female children. As would be expected based on the 
race/ethnic distribution of the population, Hispanic children accounted 
for the majority of the cancer cases and deaths. 

Leukemia was the predominant cancer type diagnosed among the bor- 
der children 2 , accounting for 46% of the incident cases (Figure 8). The 
majority of leukemias reported among children were acute lympho- 
cytic leukemias (ALL). The central nervous system was the second 
leading site for cancer cases (15%), with astrocytic brain tumors being 
the most commonly diagnosed tumor type. Lymphomas accounted for 
8% of the total childhood cancers. Almost half of the lymphomas 
reported in children during the study period were non-Hodgkin's 
lymphoma. This distribution of cancer sites is consistent with national 
and state data (Ries, et al., 1994; Weiss et al., 1996). 



* Average annual number of cases 



COMPARISON OF BORDER 
AREA WITH CALIFORNIA 1 
TOTAL CANCERS 
Males and Females 

INCIDENCE (1990-1992) 

Rate Ratio (95% CI) 
Anglo 

Male 0.98 0.95,1.01 

Female 0.95* 0.91,0.98 



Hispanic 
Male 
Female 



0.93* 
0.94* 



0.90, 0.97 
0.91,0.97 



MORTALITY (1990-1993) 

Anglo 
Male 0.91* 0.87, 0.96 
Female 0.91* 0.87, 0.96 



Comparison with California Rates 

Age-adjusted incidence and mortality rates for the border area 
were compared with cancer rates for the state of California 
(Perkins et al, 1995). California was chosen as the compari- 
son population because of the availability of Hispanic-specific rates for 
this state (see Technical Notes). 

ADULT CANCERS 

With the exception of mortality in Hispanic males, incidence and mor- 
tality rates for all cancers combined were lower in the Texas-Mexico 
border area as compared to California. Differences in rates were more 
pronounced when the data were compared for the individual cancer 
sites (Appendix I, Table 3). Generally, for sites with a statistically 
significant difference in rates, Texans in the border area experienced 
lower incidence and mortality than the California population. 



Hispanic 
Male 
Female 



1.08* 
0.95* 



1.03, 1.13 
0.91,0.99 



'Statistically significant 

California average annual incidence and 
mortality rates, 1988-1992. 



Site-specific data for childhood cancer mortality is not presented in this report (see 
'Primary Site Codes" section in the Technical Notes). 



Leading cancer sites 



ANGLO MALES 



Incidence 



liver 
larynx 


kidney 




esophagus 






bladder 


rectum 3 
prostate 3 


stomach 3 
melanoma 
brain 

non-Hodgkin's 
mult, mveloma 



HISPANIC MALES 



Incidence 



buccal" 
liver 3 

gallbladder 
soft tissue 
Hodgkin's 


bladder 
mult, myeloma 




esophagus 
bone 




prostate 2 
brain 






colon 2 
rectum * 
melanoma 



ANGLO FEMALES 



Incidence 



liver 3 

soft tissue 
cervix 


leukemia 3 


kidney 
Hodgkin's 3 


brain 
non-Hodgkin's 






esophagus 
gallbladder 


buccal 
bladder 


rectum 2,3 
pancreas 2,3 
lung 2 ' 2 
melanoma 



HISPANIC FEMALES 



Incidence 



o 

5 



liver 3 
bone 

soft tissue 
cervix' 

kidney 2 


thyroid 




buccal 
melanoma 2 




ovary 

mult, myeloma 






colon 2 ' , 
rectum ' J 
lung 23 J, 
corpus uteri 
other female 
bladder 
brain' 



Categories presented indicate excesses or deficits in 
Texas border area rates of 1 0% or more when com- 
pared to California rates. Comparisons are presented 
only for sites with stable rates (i.e. > = 1 cases/deaths) 
for both border area incidence and mortality data. 

Statistically significant difference in incidence rates. 



Incidence 

Hispanic males had statistically significantly lower incidence of colon 
(20%), rectum (28%) and prostate cancers (15%), but almost two- 
fold higher incidence for cancer of the peritoneum (based on 12 cases 
in the border data). The only site showing a significant difference in 
rates among Anglo males was breast cancer, with border area males 
experiencing approximately twice the rate of California males (also 
based on 12 cases in the three-year study period). 



Anglo females had no significantly increased site-specific incidence rates. 
However, they did have significantly lower incidence of rectum (26%), 
pancreas (3 1 %), lung ( 1 5%), melanoma (27%), and corpus uteri (24%) 
cancers. Border area Hispanic females had 23% greater incidence of 
kidney cancer. In contrast, this group had lower incidence of colon 
(21%>), rectum (28%), lung (15%), melanoma (47%), and corpus uteri 
(27%). 

Mortality 

All race/ethnic groups experienced statistically significantly lower 
mortality due to cancer of the rectum. In addition, Anglo males had 
lower rates of stomach (35%) and prostate (19%) cancers. Mortality 
rates were significantly increased for buccal (49%) and liver (55%) 
cancers in Hispanic males, and bone cancer in Anglo males was more 
than three times that of California males (based on a total of 1 1 cases). 



Mortality rates for Hispanic females were significantly lower for co- 
lon, lung, brain, corpus uteri and "other" female genital cancers and 
significantly higher for liver (32%) and cervical (33%) cancers. Anglo 
females had statistically significantly lower mortality due to lung (20%) 
and pancreas (23%) cancers, and significantly higher mortality due to 
leukemia (33%). Additionally, Anglo women had approximately two- 
fold and higher rates of mortality due to Hodgkin's lymphoma, liver, 
and soft tissue cancers. 



Statistically significant difference in mortality rates. 



COMPARISON OF BORDER CHILDHOOD CANCERS 

AREA WITH CALIFORNIA 
CHILDHOOD CANCERS 
Males and Females, Ages 0-14, 
1990-1992. 







Rate 










Ratio 


95% C.I. 


Total cancers 








f 


Anglo 


1.09 


0.66, 


1.82 


Hispanic 


1.05 


0.86, 


1.29 



Anglo 1-75* 1.12,2.72 

Hispanic 1.08 0.87, 1.35 

Leukemia 

♦ Anglo — 2 

Hispanic 1.38* 1.04,1.84 



Anglo 1.44 0.59,3.47 
Hispanic 1.34 0.96, 1.87 



Central Nervous System 

jk Anglo 1.77 0.73,4.30 



9 



Hispanic 0.88 0.51, 1.52 

Anglo — 2 

Hispanic 0.89 0.50, 1.61 



'Statistically significant. 

California average annual incidence rates, 
1988-1992. 

2 

Insufficient number of cases to allow for 
stable rate comparisons (n<5). 



Cancer incidence rates for the leading childhood cancer sites (leuke- 
mias and central nervous system) as well as total cancer incidence in 
ages 0-14 were compared with California rates for Anglo and Hispanic 
children. Numbers of cancers for the remaining sites were too small to 
allow for comparison . 

Incidence rates for all cancers combined among Hispanic children and 
Anglo males were similar to California rates. However, Anglo females 
had statistically higher total cancer incidence, although no one specific 
cancer site was significantly elevated. Hispanic males in the border 
area had a significantly higher (38%) incidence of leukemia. Rates 
among females of both races were elevated, however, the differences 
were not statistically significant. There were too few cases to compare 
leukemia rates among Anglo males (n<5). 

Anglo males had a non-significant elevated incidence of central ner- 
vous system tumors, while Hispanic children experienced equivalent 
or lower rates when compared with California. As with leukemia in 
Anglo males, there were too few cases to allow a comparison of rates 
for central nervous system tumors in Anglo females. 



DISCUSSION 



T|he types of cancers and the magnitude of cancer rates varied 
substantially among the different groups that comprise the popu- 
lation of the Texas-Mexico border area. Hispanics, both males 
and females, generally experienced much lower rates of cancer inci- 
dence and mortality than Anglo residents of the study area. This is 
largely due to low incidence rates in Hispanics of the leading types of 
cancers (e.g. lung, breast, colon, and prostate). However, incidence 
and mortality rates for stomach, liver and gallbladder cancers were 
statistically significantly higher in Hispanics than Anglos, a pattern that 
was also seen in a study of cancer among Hispanic populations in the 
U.S. (Trapedo, etal., 1995). 



Figure 9 

PROSTATE CANCER 
INCIDENCE (1990-1992) AND 
MORTALITY (1990-1993) 
Anglo and Hispanic Males 



140 



120 



O 100 



O 80 




Incidence 



Mortality 



Figure 10 

CERVICAL CANCER 
INCIDENCE (1990-1992) AND 
MORTALITY (1990-1 993) 
Anglo and Hispanic Females 



20 



15 



2 10 



1 1 - 

Incidence Mortality 



| Anglo 
| Hispanic 



The reasons for elevated rates of these particular cancers in Hispanics 
are not clear. However, it is probable that variable genetic susceptibil- 
ity, differential exposure to environmental agents and cultural prac- 
tices are all contributory factors. 

The differences in the Anglo and Hispanic cancer experiences were 
accentuated when the data were examined by gender. Stomach cancer 
clearly plays a larger role in the burden of cancer among Hispanic males. 
This cancer site was the fourth leading type of cancer diagnosed among 
Hispanic males, but ranked 13th for cancer incidence among Anglo 
males. Although the leading incident cancers for both Hispanic and 
Anglo males were prostate, lung and colon, Anglo rates were almost 
double the Hispanic rates. Despite the much higher incidence rate of 
prostate cancer in Anglo males, the mortality rate for this cancer was 
approximately equal for males in both race/ethnic groups (Figure 9). 
This may indicate that either: 1) there is differential access to or utiliza- 
tion of medical resources among Hispanic males diagnosed with pros- 
tate cancer; or 2) more cases are diagnosed at a late stage, resulting in 
poorer survival among Hispanic males. 

Differences in cancer incidence and mortality were also seen among 
Hispanic and Anglo females in the study area. Lung cancer surpassed 
breast cancer as the leading cause of cancer mortality in Anglo, but not 
Hispanic women, possibly reflecting differences in past smoking be- 
havior. In contrast, cervical cancer incidence and mortality rates among 
Hispanic women were twice that of Anglo women (Figure 1 0). Screen- 
ing based on the Pap test effectively reduces risk of developing or dy- 
ing from this cancer. The greater incidence and mortality for cervical 
cancer in Hispanic women living in the border area indicates a need for 
increased screening efforts targeted to this high-risk population. 

Comparison of Texas-Mexico border area cancer statistics with those 
of California, a state with a similar racial/ethnic composition, indicated 
that the border area had equivalent or lower incidence and mortality 
rates for most cancer sites in adults. With the exception of liver can- 
cer, this was also true for comparisons of border area Hispanics to 
California Hispanics and border area Anglos to California Anglos. 
Liver cancer incidence and mortality rates were elevated among all 
border area residents, but only mortality rates were statistically signifi- 
cantly different from California rates. A pattern of increasing liver 



Figure 11 

COMPARISON OF BORDER 
CANCER MORTALITY WITH 
TEXAS (1981-1 991 ) 1 
Males and Females 



TOTAL CANCERS 




Males 



Females 



LUNG CANCER 




Males 



Females 



■ 


Border Anglo 


u 


Other TX Anglo 


u 


Border Hispanic 


u 


Other TXHspanic 



Rates are per 100,000 population and are 
adjusted to 1970 U.S. standard million popu- 
lation. 

Reproduced from data presented at the 
1993 Environmental Border Health Confer- 
ence, San Antonio, Texas, and the 1995 
U.S. -Mexico Border Conference on 
Women's Health, South Padre, Texas. 



cancer mortality rates has been noted among Texas Anglo and Hispan- 
ics statewide over the period 1984-1993 (TCR data not presented). 
Reasons for these elevated rates are not clear. Known risk factors for 
primary liver cancer include chronic hepatitis B infection, alcoholic 
cirrhosis, and aflatoxin and occupational vinyl chloride exposures 
(Higginson, et al., 1992). 

Although it was not possible to compare cancer incidence along the 
border with the rest of Texas, a previous study by the TCR found that 
cancer mortality rates among border residents were similar to or lower 
than rates for the state as a whole (data presented at the 1993 Environ- 
mental Border Health Conference, San Antonio, Texas, and the 1995 
U.S. -Mexico Border Conference on Women's Health, South Padre, 
Texas)(Figure 11). 

Cancers occurring among children ages 0-14 showed the same distri- 
bution of leading sites as national data, with leukemias and central 
nervous system tumors accounting for over half of all cancers diag- 
nosed in this age group. In comparison with the California data for this 
age group, only total cancers in Anglo females and leukemias in His- 
panic males were statistically higher among the border population than 
their California counterparts. The childhood data in this report were 
used to conduct an informal follow-up to a previous cancer cluster 
investigation of childhood cancers along the border and these data in- 
dicate that the elevation of leukemias in Hispanic males is largely driven 
by a significantly higher than expected number of acute lymphocytic 
leukemia (ALL) cases (data not presented). ALL was not significantly 
elevated in Hispanic females or Anglos of either sex. In contrast, acute 
non-lymphocytic leukemia (ANLL) occurred almost three-fold sig- 
nificantly higher than expected among Hispanic females, but not among 
other border children. 

This inconsistent pattern of elevated rates in childhood cancers is not 
generally compatible with an environmental exposure, i.e., there is no 
apparent reason to believe that exposure to some carcinogen ubiqui- 
tous in the environment would differentially affect male but not female 
children, or vice versa. However, because childhood leukemia has 
been associated with various environmental exposures (e.g. radiation, 
alkylating agents, chloramphenicol, and pesticides), the TCR will con- 
tinue to monitor incidence of childhood cancers in the border area. In 
addition, the Registry is pursuing collaboration with academic research- 
ers interested in studying cancer incidence among children living in the 
Texas-Mexico border area. 



10 



ESTIMATED PROPORTION 
OF CANCER DEATHS 
ATTRIBUTABLE TO 
CIGARETTE SMOKING 



Cancer site 


Percent 


lung 


85 


larynx & oral 


50-70 


cavity 




esophagus 


50 


bladder & kidney 


30-40 


pancreas 


30 


ALL CANCER DEATHS 30 



(Source: United States Public Health 
Service (1982)) 



From a public health perspective, it is important to note that the lead- 
ing cause of cancer death among residents of the Texas-Mexico border 
area was lung cancer. The major risk factor for this cancer, consump- 
tion of tobacco products, is completely avoidable through modifica- 
tion of personal behavior. It is estimated that approximately 85% of 
diagnosed lung cancers are directly related to smoking (Ernster and 
Cummings, 1991). Additionally, smoking has been linked to cancers 
of the larynx, oral cavity, esophagus, bladder, kidney and pancreas. 
The elimination of this risk factor alone would potentially result in 580 
fewer cancer deaths per year in the border area. 

Cancer mortality also can be reduced through the use of routine screen- 
ing for cancers of the breast, cervix, and possibly prostate. Early de- 
tection of these cancers radically increases the probability of surviving. 
The 5-year relative survival rate among women diagnosed with breast 
cancer detected while still localized has risen from 78% in the 1940's 
to the current rate of 94% (ACS, 1995). The 5-year relative survival 
rates for early-stage prostate and cervical cancers are 94% and 90%, 
respectively. 



Data-based interventions hold the most promise for reducing the rates 
of cancer incidence and mortality among Texas residents of the border 
area (Suarez, et al, 1991). Using the Texas Cancer Registry data pre- 
sented in this report, interventions such as smoking cessation and 
screening programs can be tailored specifically to high-risk groups 
within the border population. Evaluation of the impact of cancer con- 
trol efforts on both cancer incidence and mortality in the border area is 
also possible through use of Registry data. 

Although intervention strategies are available for some cancers, can- 
cer control efforts are limited by the lack of knowledge of the causes of 
most cancers. This report presents evidence of clearly differing pat- 
terns of cancer among Anglos and Hispanics living in the Texas-Mexico 
border area, a finding that can serve as a basis for developing hypoth- 
eses for etiologic research. 



11 



12 



[^ llmJC J 



TECHNICAL NOTES 



13 



Technical Notes 



Sources of Data 



The TCR is a population-based cancer incidence reporting system that collects all incident reports of 
neoplasms occurring among Texas residents. Reports of cancer are submitted primarily by Texas 
hospitals and cancer treatment centers, along with outpatient clinics and free-standing pathology labs. 
TDH does not currently have a cancer data sharing agreement with Mexico. Consequently, cancers 
among Texas residents that are diagnosed and treated in Mexico are not available for analysis by the 
TCR. 

The incidence data analyzed for this report was primarily abstracted from medical records and pathology 
reports. All reports of cancer received from the 18-county area were reviewed to eliminate inclusion of 
multiple reports for a single case and to determine primary cancer sites. Only primary malignant 
neoplasms were included in these analyses. 

Cancer mortality data were extracted from computerized mortality files provided by the Bureau of Vital 
Statistics, Texas Department of Health. These mortality files contain demographic and cause of death 
information for all deaths occurring among Texas residents. For the purposes of this report, only deaths 
listing cancer as the underlying cause were included. 

Indicators of Cancer Incidence Data Quality 

The percentage of cases microscopically confirmed measures the quality of the diagnostic information 
used to assign the primary site. A case is microscopically confirmed if the diagnosis is based on autopsy, 
histology, cytology, or hematology findings. For the border area data, 91 percent of the total cancers 
were microscopically confirmed (Appendix II). This percentage compares favorably with the 92 percent 
confirmation reported by SEER (US Dept Health and Human Services, 1988). 

To identify any cancer cases not reported to the TCR, information on all death certificates with the 
underlying cause of death due to malignant neoplasm was obtained from the Bureau of Vital Statistics, 
Texas Department of Health. Institutions listed on the death certificates as place of death were queried 
for additional cancer case information. Missed cases not identified from any institution were added to 
the TCR database. Cases for which the only available information is the death certificate, classified as 
"death certificate only" cases, were included in this report. Unless information was provided on the 
certificate, the date of death was considered to be the date of diagnosis for these cases. The percentage 
of death certificate only cases is presented by primary site in Appendix II. Of the 13,068 malignant 
cases, 4.8% were reported by death certificate only. This is slightly higher than the 3% standard 
suggested by the North American Association of Central Cancer Registries. 



14 



Primary Site Codes 

Uniform cancer site coding schemes were used in this report to allow for comparison of Texas cancer 
incidence and mortality data with other state and national cancer data. Primary site and histologic type 
were coded for each cancer incident case using the International Classification of Diseases for Oncology 
(ICD-O) (WHO, 1976). The ICD-0 codes corresponding to each primary site category in this report 
are presented in Appendix III. 

For cancer mortality, the cancer sites presented correspond to site groupings (140-208) used by the 
National Cancer Institute (NCI) for the 9th Revision of the International Classification of Diseases (ICD- 
9) National Center for Health Statistics mortality data (WHO, 1977). The ICD-9 codes corresponding 
to the site groupings of the cancer deaths are shown in Appendix IV. 

Childhood cancer site codes were assigned according to a classification scheme based primarily on 
cancer cell type (Birch and Marsden, 1987). This differs from the coding scheme for adult cancers, 
which is based primarily on cancer site. Data on cell type is not available directly from death certificate 
information and consequently, site-specific information on cancer deaths in children living in the study 
area is not presented in this report. 

Race and Ethnicity of Cancer Cases and Deaths 

Race and ethnicity was determined for each cancer patient based on information available from their 
medical records and classified according to SEER categories (SEER, 1983). Two categories are used 
to describe Caucasians: 1) Caucasians of Spanish surname or origin, and 2) Caucasian, not otherwise 
specified. These categories are referred to in this report as "Hispanic" and "Anglo," respectively. 

As a quality control check of the Hispanic category, the Generally Useful Ethnic Search System 
(GUESS) program developed by Robert Buechley was used to classify cases into Spanish and non- 
Spanish surname categories (Buechley, 1976). Discrepancies were resolved by reviewing information 
on the original hospital abstracts. For this report, all cases of other or unknown race (61 cases or 0.4%) 
were included in the Anglo category. 

The definition of the race and ethnicity categories for the cancer deaths is slightly different than that of 
the cases. Cancer deaths were categorized into three race/ethnic groups: Anglos, Hispanics and Blacks 
(African Americans). These three technically represent Blacks, non-Black Hispanics, and all others (non- 
Black, non-Hispanic). African American statistics are not presented in this report due to the small 
number of cancer cases and deaths among this race/ethnic group in the study area. The Hispanic 
category was based on Spanish surname as indicated by the GUESS program. Those deaths coded as 
"other" in the mortality data (20 or 0.2%) were included in the Anglo category. 

Population Data 

Estimates of the population for use in the calculation of age-specific and race/ethnicity-specific rates of 
cancer in the Texas-Mexico border counties were obtained from the Texas Department of Health, 
Bureau of State Health Data and Policy Analysis (Appendix V). 



15 



Data Analyses 

Average annual incidence and mortality rates were age-adjusted using the direct method. Age 
adjustment eliminates the effects of different age structures in populations, allowing for direct 
comparison of incidence and mortality rates. Direct standardization weights the age-specific rates for 
a given sex, race/ethnicity or geographic area by the age distribution of the standard population. The 
1970 United States standard million population was used as the standard for all rate calculations. 

The formula to calculate age-adjusted incidence and mortality rates is: 



2 'a Pa 

a= 1 

Age-adjusted Rate = x 100,000 

n 

23 Pa 

a= 1 



where i a = the age-specific incidence/mortality rate for age group a 

P a = the standard US population in each age group a 
n = the number of age groups (16 five-year age groups) 

Rates were calculated using five-year age intervals for ages <1 to 74 years, with persons 75 years and 
over grouped into one interval. 

One measure of the reliability of a rate is the standard error (SE) which can be approximated as the age- 
adjusted rate divided by the square root of the number of cases or deaths from which the rate was 
calculated (Keyfitz, 1966). To further determine the magnitude of variability of an age-adjusted rate, 
a 95% confidence interval (CI) can be calculated using this approximated standard error. The formula 
for calculating a 95% confidence interval for a population rate is as follows: 

95%CI = r±(RCxSE) 

where r = the age-adjusted rate 

RC = the reliability coefficient (1.96 at the 95% level) 

SE = r//d 

d = the number of observed cases or deaths 

Comparisons were made of the Texas-Mexico border area age-adjusted incidence and mortality rates 
with California rates. California was chosen as a comparison population due to the availability of 
Hispanic incidence and mortality rates; Hispanic rates are not presented in the National Cancer Institute's 
SEER program data reports. There were several factors which precluded a comparison of the border 
area rates with rates for the rest of Texas. The lack of statewide data has required the TCR to estimate 



16 



cancer incidence rates for the state of Texas based on those Public Health Regions (PHRs) with 
complete cancer incidence reporting (PHRs 1, 5, 8, 10, and 11). Unfortunately, the Hispanic population 
in the border area comprised over 80% of the total Hispanic population used to calculate the estimated 
statewide rate. Because of this weighting of the Hispanic data by the border population, 1) comparing 
the border area incidence rates to the estimated statewide rate would show no discernable difference in 
rates, and 2) removing the border counties from the statewide estimated rates would result in unstable 
Hispanic comparison rates due to small numbers. Although a comparison of incidence rates was 
therefore not feasible, a previous comparison of border area mortality rates with Texas mortality rates 
showed lower or similar rates for most cancer sites (data presented at the 1993 Environmental Border 
Health Conference, San Antonio, Texas and the 1995 U.S. -Mexico Border Conference on Women's 
Health, South Padre, Texas). 

The California comparisons were done using the rate ratio method. Confidence intervals for these rate 
ratios were calculated based on a logarithmic transformation method described by Rothman (Rothman, 
1986). Confidence intervals which do not include 1.0 indicate a statistically significant difference in 
rates. Due to the instability of rates based on small numbers, only those sites with 1 or more cases or 
deaths for the total time period in the Texas data were compared. The rates used to calculate rate ratios 
for comparing the Texas border area and California childhood cancer data were not age-adjusted, i.e. 
these rates were treated as age-specific rates for ages 0-14 years. 



17 



18 



[^ flm<CJ 



LITERATURE CITED 



19 



Literature Cited 



American Cancer Society (ACS). Cancer Facts & Figures - 1995. American Cancer Society, Inc., 
Atlanta, GA, 1995. 

Birch JM, Marsden HB. A classification scheme for childhood cancer. Int J Can 1987;40:620-624. 

Buechley RW. Generally useful ethnic search system, GUESS. Presented to the annual meeting of the 
American Name Society, December, 1976. 

Ernster VL, Cummings SR. Smoking and Cancer in American Cancer Society Textbook of Clinical 
Oncology , eds Holleb AI, Fink DJ, Murphy GP. American Cancer Society, Inc., Atlanta, GA, 1991. 

Higginson J, Muir CS, Munoz N. Human Cancer: Epidemiology and Environmental Causes. 
Cambrige .Cambridge University Press, 1992. 

Keyfitz N. Sampling variance of standardized mortality rates. Hum Biol 1966;38:309-3 17. 

Perkins CI, Morris CR, Wright WE, and Young XL. Cancer Incidence and Mortality in California by 
Detailed Race/Ethnicity, 1988-1992. Sacramento, CA: California Department of Health Services, Cancer 
Surveillance Section, April 1995. 

Ries LAG, Miller BA, Hankey BF, Kosary CL, Harras A, Edwards BK (eds). SEER Cancer Statistics 
Review, 1973-1991: Tables and Graphs, National Cancer Institute. NIH Pub. No. 94-2789. Bethesda, 
MD, 1994. 

Rothman KJ. Modern Epidemiology. Boston/Toronto: Little, Brown and Company, 1986. 

SEER Program. The SEER Program Code Manual. Bethesda: National Cancer Institute, 1983. 

Suarez L, Martin J, Weiss N. Data-based interventions for cancer control in Texas. Tex Med 
1991;87(8):70-77. 

Trapido EJ, Valdez RB, Obeso JL, Strickman- Stein N, Rotger A, Perez-Stable EJ. Epidemiology of 
cancer among Hispanics in the United States. Monogr Natl Cancer Inst 18: 17-28, 1995. 

U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, 
National Cancer Institute. Annual Cancer Statistics Review including Cancer Trends: 1950-1985. NIH 
Publication No. 88-2789, 1988. 



20 



Weiss NS, Katz JA, Frankel LS, et al. Incidence of childhood and adolescent cancer in Texas. Tex Med 
1996;92(7):54-60. 

World Health Organization (WHO). International Classification of Diseases for Oncology, 1976. 
Geneva, Switzerland: WHO, 1976. 

World Health Organization (WHO). Manual of the International Statistical Classification of Disease, 
Injuries and Causes of Death. Ninth revision, Vol. 1. Geneva, Switzerland: WHO, 1977. 



21 



22 



[ ^1 fUC J 

APPENDICES 



23 



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24 



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CO CO CO 
CN 



CO 



en 



CO 



CO 



t- CN 

xt -t 

CN 



00 


CN 

oo 


o 


in 


o 

CO 


CO 


in 

CO 


00 

X — 


o 


x — 


o 


T_ 


m 
o 


in 

CN 
CO 


CO 

m 


00 
CN 


oo 

CO 


co 

CN 



o 
o 



o 
o 



o 
o 











CO 












m 












c 












CD 












O) 












CD 






■,_ 










'l 


CD 


to 




CO 




CD 


3 


o 

c 




b 




13 











ID 




(0 










X 

CD 


3 
Q_ 

O 


(0 


c^ 

CO 

> 


CD 

JO. 


CO 

"to 
o 


o 


O 


Z> 


O 


O 


o_ 



<- £i en 

<o 

cu 



co 

c 

CO 
O) 

o 

CO 

E 



to 

'c 

CD 
0. 



(/) 







o 






S 






CD 






C 






CO 










cT 


r 




CO 


CD 




c 


o 










3 


u 


t_ 




c 


CD 


>> 


CO 


T3 


CD 




a 


cr 




CO 


T3 


CO 


DO 


*: 


CD 



■* 
r^ 





00 
CO 


o 
o 


CN 


CO 


oo 


o 


CM 


r^ 


CO 


CO 


T— 


00 


CO 


CN 


m 


CO 

in 


in 


o 

CO 


00 
CO 


■M- 



o 


m 


in 


O 


r^ 


CO 


o 


o 


o 


O) 


o 


CN 


CO 


CM 


o 


T- 


o 


CO 


T— 


h-; 


r^ 


CO 


p 


p 


p 


1^; 


CN 


CO 


in 


CN 


CO 


CM 


■* 


CT> 


1^ 


O 


co' 


o 


d 


o 


o 


in 


■^ 


CD 


00 


CM 


CO 


co' 


T— 




T— 




t — 




















T— 




T ~ 
































a> 


Tf 


h- 


r~- 


N. 


h- 


o 


o 


o 


T — 


■<t 


r-- 


CO 


.,_ 


■**- 


N- 


a> 


in 


CM 




T— 










m 


CO 


CO 


■M- 


T— 


o 


CN 


r*~ 




t— 




T— 




















T— 





o 
o 


o 
o 


o 
o 


o 
o 


o 
o 


oo 

CO 


CN 


oo 




*( — 


in 
CN 




OO 


o 


o 


o 


o 


o 


o 


o 


CO 


CN 


T— 


,,— 


CN 

i — 


<<3- 


' ,— 


CN 


CN 


Tt- 


o 


o 


o 


o 


o 


O) 

CN 
oo 


CD 


Tt 


T — 

CO 

^ — 


m 

T— 


CD 


CO 
CN 


O 


00 

in 


co 
in 



CO 


O 
O 


o 
o 


o 
o 


o 
o 


o 

o 


in 

CD 




o 


CN 


CN 


o 


O) 


in 
oo 


in 

i — 


00 


1 


o 


o 


o 


o 


o 


CO 
CO 


in 


o 


CD 
CN 


o 


r~- 


CN 


CN 


CO 


CO 


CN 


o 


o 


o 


o 


o 


CN 

in 
o 


o> 

CN 


CD 


o> 


co 


CO 


oo 


CN 

T 


CO 

o 


oo 

CN 



o 





CO 






E 






o 




CO 


JO 




E 
o 

JO 


E 

>- 


CO 

E 
o 


F 




_>. 


s 


>N 


y> 


D) 
T3 


E 


c 


O 


CD 


n> 


I 
i 


Q. 


T3 


C 


^ 


o 


o 


ZJ 


I 


Z 


^ 



co 



CN 
O 






CD 


o 
o 


o 
o 


o 
o 


o 
o 


o 
o 


00 


CO 

in 


o 


o 

CO 




O 


o 

CM 


CO 

in 


00 


CM 

in 


CN 


O 


o 


o 


o 


o 


o 




co 


T— 


r>- 


X — 


Tl" 


CN 


CM 


CO 


Tt 


T— 


CO 


o 


o 


o 


o 


o 


CO 
CO 


o 


o 

CN 


CM 

CN 
CO 


CO 

T — 

CN 


t — 

o 


5 


CN 

in 


CD 
CN 


00 


CO 

CO 
CN 



CD 

m 
en 






n 

E 

a- 

cu 





c 



















4-« 






od 












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a. 






5 






L_ 






o 






r~ 






0" 




(N 


!/-) 




0\ 


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U 


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JO 


c> 


R 




ej> 




s 


^- 


~1 


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3 


r 


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s 


u 


5 


— 


t_ 


XJ 


5 




1 






u 


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o 




■^3 
a 


o 

o 


r; 


v: 


o 


fl 


E 


c 


- 


u 


b 


■/5 

— i 


(O 

U 


L_ 


a 






"I 


•J 






i 


s 


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1/1 


•^ 








5 


oq 


', 


i— 


Qi 


f- 



25 



• I— I 

o 

• I— I 

I 

o 

a 

5-H 






03 




ts 




o 




a 




T3 




<D 




4-> 




C/l 




3 




^ 




<S 




<D 




bo 




ed 




*— 4 




o3 




g 




D 


CO 


bi) On 


cd 


On 


S-i 




CD 


■ 


> 


O 


OS 


On 


T3 


On 




' ' 




a 


r/i 


<L> 


-5 


* 


Oj 


}— 


<L> 


<1> 


T3 


T3 


0) 


O 


o 


X2 


o 

5+H 


O 
O 

■a 


o 


<L> 


i-i 


2 
i 


,0 


C/l 




cs 


H 


X 


£ 


0) 

H 


<N 




<L> 








,P 




03 




H 















a) 






-*-» 






(0 




-J 


£ 




< 






I— 






o 


co 




t- 


cd 




Q 






CD 


(/) 




-4-» 

co 


UJ 


O 


Ct 


_l 


..Z 




< 

2 


< 


co 


lil 


X 


"to 


u_ 




Q 

•4-* 

CO 




o 


a: 




_J 






a 






z 


to 




< 


JZ 

-4-< 

co 
Q 






CD 






*-» 






CD 








_1 


Li- 




< 






H 






O 


co 




m 


-C 

•♦-^ 

CO 
CD 

Q 
CD 

•4— ' 


CO 


o 


CO 


UJ 


z 




_l 


< 




< 


0- 


w 


s 


JZ. 
CO 






d) 






ri 












m 






^■* 






CO 




O 


or 




_i 






o 






z 


to 




< 


x; 

CO 






CD 






Q 




UJ 






h- 












(0 






01 






UJ 






o 






2! 






< 






o 





CO 



CO 
OJ 



CO 
CNI 



CM 
O O 



APPENDIX I 
Tables 



lO O) v- 

T- (O h- 

t^ d ■<* 



in 



o> 
iri 



^ 


CO 


CM 

in 


co 
in 


o 


CM 


"* 


in 

CO 


o 


r^ 


o 


CO 


CM 


CD 


O 


o 


o 


oo 


CM 

in 


O) 
CM 


h- 


CM 

oo 


CO 


OO 


Tf 


CM 


CO 

o 



CO 



CO 

d 



in 



CM 



CM 



m co cm oo in oo o 
CM 00 CM CO r>- CM CM 

o o 



CO 
CM 



in 



CO CD 



CD 



CO 
CM 
CM 



o 

CM 


o> 


CM 
CM 


T — 


CO 


CO 
CO 


o 


O) 
CO 


(D 


"* 


CD 


in 

CM 


CO 


O) 


CO 

o 




O) 
CO 


o 

05 


CD 


CM 

o> 


CO 

in 


CO 

T— 


O 

o 


in 
in 


O) 
CM 


o 
o 


T— 


T— 


CM 


CM 


O 


CM 


O 


m 


o 


o 


o 


o 

CO 


o 


r^ 


Tf 


CM 

CO 


5 


T— 


O) 
CM 


CM 

t — 




CM 


o 


CD 


O) 

co 


o 



> 


to 










m 


3 










n 


O) 


JZ. 










CO 


O 




b 




CO 


x: 


CO 


c 


■zi 




CJ 

o 


Q. 
O 


b 
o 


o 


o 


CD 


3 


CA 


o 


CD 


> 


QQ 


LU 


C/) 


O 


cc 


_l 









CO 












CD 












TJ 












C 




<J) 








CO 




13 

JZ. 


L- 




E 


U) 




C) 


CD 




3 




c 


•o 


CO 


=i 


tz 




o 


TJ 


CO 


CD 


CO 




X2 


CO 


CD 


C 




x 


X2 


O 


o 


CO 


c 


rS 


— . 


c 


k- 


CO 


f* 1 


c 


lU 


CO 


CD 


CO 


CO 


3 


O 


a. 


Q_ 


z 


_l 


_l 



r^ 
■* 



CD 





CD 




3 




10 




CO 


CD 


+-» 


C 


*i 


o 


o 


00 


CO 



t- o) in 

"* CM <D 

O T^ O 



O GO ^ 

t- CM t- 



CO CO 05 
CO CM CO 

O CM -r^ 



in oo in 



en 

00 


co 


oo 
q 


in 


CM 


CO 


o 


o 
o 


CO 


CM 
CM 




o> 


CO 


o 

CO 


oo 
o 


o 

CD 


CO 


■>* 


oo' 


CM 




r-i 




o> 


d 


d 


^~ 




d 


d 






CO 
O) 


CM 

o 


CM 

o 

CM 


o 

CO 


"«*• 
■* 


in 

00 


in 

CO 


in 

CM 
CM 


00 


CD 




O 
CO 

T— 


-3- 


CM 


CO 
CM 


""a- 


CM 


O) 


CM 

CO 


CO 

in 


CO 

in 




■^l- 


r^ 


co 


in 


CO 

cp 


CO 

q 


m 


in 


TJ- 

CM 


CM 


co" 


CO 


d 


a! 


T— 


o* 


CM 


00 


d 


d 


^* 


CD 
CO 


d 


d 


" 


d 


in 


in 


CO 
CD 




m 

CM 


CM 


CO 


CO 


in 


CO 


CO 
CM 


co 
in 


CM 


o 


CM 


CM 


CO 
CM 


00 
00 


oo 


O) 


CO 


O 
1^- 


in 

CO 


o 

■<fr 


CO 
CM 


o 


in 

CO 


o 


CM 
CM 


CO 


O 
CO 


in 


■^ 


■^ 


CO 


iri 


^~" 


■* 


d 


O) 


d 


d 


c\i 


d 

CO 


d 


t— 


d 


CO 


o 

CO 


in 


CO 


1^ 

in 


O) 


CO 


■>* 


O) 


CO 


CO 


CO 
CM 


CO 
OJ 

in 


CM 


^ 


1^ 


O) 
CM 



3 

o 
r- 



ON p 

s £ -e 

o\ o -^ 
^ "S -^ 

&*$ 

^ 8 -53 
^ § "| 

5 o ^ 

0,0 o 

w i-i m 
-a ^ .S 

, — . trt — i 
son) 

o "S "5 



26 



T3 



C 

o 
O 

CN 

JL) 

H 













a> 






*-» 






ro 




_J 


QL 




< 






H 






O 


</> 




H 


ro 


a 






<D 


(0 




»>4 
CO 


HI 


o 


a: 


J 


Z 




< 


< 
CO 




HI 


X 


CO 


LL 






Q 



*-* 

CO 




O 


a: 




_i 






o 






z 


w 




< 


•4— » 
ro 
© 
Q 


ro 




_l 


01 




< 






H 






o 


w 




h- 


x: 
ro 

0) 

a 






© 








C/> 


o 


ro 


LU 


z 




_J 


< 




< 


a. 

CO 

X 


(0 


2 


ro 






ro 






Q 



















ro 




o 


m 




_J 






o 






z 


w 




< 


ro 



Q 




u. 


1 




»- 






a 


) 




a 


1 




Li 


i 




CJ 


> 




z 


i 




< 






c 


i 













APPENDIX I 






















Tables 












o 
o 


CO 


CM 


CO 


o 

in 


O O O CO CO 
O p O O) ^ 


CO 






CN 


CO 
CN 


d 

CN 


•>* 


d 


CO 


o 


O O O O CM 


CN 


d 


d 


■* 


CN 



CO 
CO 


o 

CO 


CO 
CN 


o> 
o 

CNI 


m 


o 


o 


o 


CO 




CO 

1^. 


CO 


co 
in 


o 

o 


o 
o 


o 
o 


r-- 


m 


o 


lO 


o 


o 


o 


o 



CM 
CO 






co ■<* 



CD 
CO 


1^- 


CD 

in 


co 

CO 


o 


CM 


T- 


o 



O) T- 

r^ co 

CO i- 



co o 

t- CM 



CD 

in 

in 

CM 



m 
in 

CM 



co 

CM 



O) 
CM 



co 
m 



o 
co 

co 



co 



CM 



cm o 
"3- O 

o d 



o 
o 

d 



o 
o 



en 
co 



co 



CM 

in 



co 
co 

CM 



CM 



in 
co 



co 
o 



co 
co 



o 
o 



m 



o 



r- o 
cm p 

d d 



o 
o 



o 
p 
d 



o 
o 



2= •<* 



co 

d d 



o 
o 



o 
o 






co 

CM 

co 



co 

CM 



S S N 
p p co 

d d ai 



r- CO 



in t- 
co co 

o d 



CN 



O 



co 



in 
co 



in 
co 



in 
in 



■<fr 



o 

CM 
CM 



CO 
CO 


o 
p 


o 
p 


o 
p 


o 
o 


CO 


in 

CO 


•<* 

CO 


co 


CO 
CN 


o 
o 


CM. 


CO 


CM 

CO 


CO 


d 


d 


d 


d 


d 


co 


d 


d 


CO 


in 


■<*' 


d 


d 


in 


co' 











,— 


O) 


"<*• 


CM 


^ — 


CO 


r^- 


CM 


Tf 


CO 


en 


CO 


o 











CO CO OT 

co p p 

d d in co 



o 



in 


o 


CM 


CN 
CD 

T— 


CD 

o 

CD 
CO 


CO 
CM 


o> 


CD 


CO 




o 


CO 


CN 


■<*■ 


o 
o 



o 



co 

CM 



CD 



CD 

in 



5 



10 

ro 



m 




















O) 















' — 







ro 




-2 


"5 




E 




-J 






0) 







(/) 








X 

'£: 



ZJ 
Q. 

O 


ro 

> 





ro 
to 
o 


o 


o 


O 


O 


o_ 



CO 

c 
ro 

O) 

k_ 
o 

_© 
ro 

E 



o fc 



ro 

c 



co 
co 



CM 



to 

0; 



to 
c 


CL 




"D 

_ro 
m 



3 


"O 




c 


>» 


ro 





i - 


c 




"D 


ro 


Ni 


m 



o 

F 



ro 

E 
o 

JCZ 
CL 

E 
J>. 

y> 
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IS 

D) 
X) 
O 

X 



m 



ro 

E 
o 

.c 

Q. 

E 
y 

"c 

.XL 
D) 

T3 
O 

X 

c 
O 

Z 



CO 
CN 



ro 

E 
o 



>- 

E 

Q. 



co 

CM 
CD 



CO T- 

CM CO 



CD 



CO t- 

co m 



CO 


m 


CO 


in 


CO 
CO 


in 


in 

^ — 


CM 
O) 


CD 

in 


CD 
O 



co 

CO 
CM 


1^- 





CD 


O) 

p 


O) 

CO 


CN 
CM 


00 
p 


in 


CO 
CD 


O 

CM 


in 

CO. 

in 


d 


d 


■* 


in 


•^ 


d 


d 


CO 


CN 


ai 


CO 



in 





CO 




a: 




LU 




O 




Z 




< 


ro 


O 


b 


1 





<f 





h- 
O 





= 













a 






ra 






3 






a 






~ 






D, 






O 






r~- 

















m 






ON 


en 




ON 


P 






u 


JU 


6 

'ON 


-£ 


B 


ON 


g 


•* 


i 




s 

1 





TO 


^1 


G- 


| 


-^ 


V 


T3 


* = ' 


■B 


I 


c 





V 


M 

O 


•^i 






3 
e 

B 


O 
O 

O 

0' 


b 


a. 


c 


5 


■J 
<5 


b 


■A 


-s 

3 


u 


_3 


— 1 


l ^ 


a 


"3 




3 








c 


9 


B 


H 


& 


h- 



27 



APPENDIX I 
Tables 

Table 3. Comparison of Texas-Mexico border area incidence (1990-1992) and 
mortality (1990-1993) rates with California rates (1988-1992). 







INCIDENCE 






MORTALITY 




CANCER 




Males 


Females 




Males 


Females 




Anglo 


Hispanic 


Anglo 


Hispanic 


Anglo 


Hispanic 


Anglo 


Hispanic 


Buccal 


1.05 


1.12 


0.99 


1.15 


1.00 


1.49* 


0.85 


0.96 


Esophageal 


1.23 


1.15 


1.23 


1.46 


0.92 


1.08 


0.72 




Stomach 


0.87 


0.91 


0.91 


0.93 


0.65* 


1.09 


0.91 


1.05 


Colon 


0.99 


0.80* 


1.00 


0.79* 


0.91 


0.89 


0.98 


0.65* 


Rectum 


0.93 


0.72* 


0.74* 


0.72* 


0.57* 


0.49* 


0.43* 


0.54* 


Liver & 


1.23 


1.18 


1.43 


1.12 


1.31 


1.55* 


1.67* 


1.32* 


intrahepatic 


















Gallbladder 


0.76 


1.32 


1.14 


1.04 




1.34 


0.84 


1.09 


Pancreas 


0.92 


0.93 


0.69* 


0.98 


0.98 


1.06 


0.77* 


1.05 


Peritoneum 




1.88* 














Nasal, sinus, 








1.75 










ear 


















Larynx 


1.22 




0.83 


1.09 


1.18 


0.99 






Lung & 


1.00 


0.99 


0.85* 


0.85* 


0.92 


1.08 


0.80* 


0.77* 


bronchus 


















Bone 




1.56 




1.29 


3.22* 


1.08 




1.37 


Soft tissue 


0.98 


1.11 


1.42 


1.31 




1.38 


2.03* 


1.17 


Melanoma 


0.87 


0.65 


0.73* 


0.53* 


0.76 


0.80 


0.77 


0.93 


Breast 


1.92* 




0.96 


0.94 






0.91 


0.97 


Cervix 


n/a 


n/a 


1.25 


1.10 


n/a 


n/a 


1.33 


1.33* 


Corpus uteri 


n/a 


n/a 


0.76* 


0.73* 


n/a 


n/a 





0.56* 


Ovary 


n/a 


n/a 


1.02 


0.88 


n/a 


n/a 


1.02 


0.98 



"No comparison done due to instability of Texas border area rates (i.e., less than 10 cases/deaths reported). 
* Statistically significant different from 1 .00 at the p^O.05 level. 



28 



Table 3. Continued. 







INCIDENCE 






MORTALITY 




CANCER 




Males 


Females 




Males 


Females 




Angle 


Hispanic 


Anglo 


Hispanic 


Anglo 


Hispanic 


Anglo 


Hispanic 


Other female 


n/a 


n/a 




0.66 


n/a 


n/a 





0.32* 


genital 


















Prostate 


1.01 


0.85* 


n/a 


n/a 


0.81* 


1.03 


n/a 


n/a 


Testis 


1.01 


1.04 


n/a 


n/a 






n/a 


n/a 


Penis 





1.18 


n/a 


n/a 








n/a 


n/a 


Bladder 


1.12 


0.99 


1.00 


0.83 


0.79 


1.18 


0.87 


0.77 


Kidney 


0.92 


1.08 


0.75 


1.23* 


1.24 


1.00 


1.13 


1.12 


Brain 


0.86 


0.80 


1.12 


0.77 


0.87 


0.98 


1.05 


0.68* 


Thyroid 


1.04 


0.90 


1.29 


1.04 








1.36 


Hodgkin's 


0.86 


1.28 


0.85 


1.21 




1.55 


2.60* 




lymphoma 


















Non-Hodgkin's 


0.83 


0.91 


1.15 


0.93 


0.82 


0.95 


0.93 


0.95 


lymphoma 


















Multiple 


0.82 


1.04 


1.04 


0.86 


0.81 


1.18 


1.05 


0.94 


myeloma 


















Leukemia 


1.04 


1.01 


1.02 


1.08 


1.07 


0.92 


1.33* 


1.03 


ALL SITES 


0.98 


0.93* 


0.95* 


0.94* 


0.91* 


1.08* 


0.91* 


0.95* 



""No comparison done due to instability of Texas border area rates (i.e., less than 10 cases/deaths reported) 
♦Statistically significant different from 1 .00 at the p=0 05 level. 



29 



APPENDIX II 

Percent of Cancer Cases Microscopically Confirmed and 

Percent of Death Certificate Only Cases 
by Primary Site, Texas-Mexico Border Area, 1990-1992 







PERCENT 


PERCENT 




NUMBER OF 


MICROSCOPICALLY 


DEATH CERTIFICATE 


PRIMARY SITE 


CASES 


CONFIRMED 


ONLY 


Buccal cavity 


332 


95.2 


3.9 


Esophagus 


139 


93.5 


4.3 


Stomach 


363 


92.8 


5.0 


Colon 


942 


94.4 


4.1 


Rectum 


366 


95.9 


2.5 


Liver 


195 


68.2 


21.0 


Gallbladder 


152 


85.5 


8.6 


Pancreas 


323 


73.7 


12.1 


Peritoneum 


29 


93.1 


6.9 


Nasal, Sinus and Ear 


29 


89.7 


6.9 


Larynx 


164 


93.9 


5.5 


Lung, Bronchus 


1707 


84.7 


8.9 


Pleura 


22 


86.4 


9.1 


Bone 


47 


95.7 


2.1 


Soft Tissue 


103 


94.2 


1.0 


Melanoma of Skin 


191 


97.4 


1.6 


Breast 


1869 


96.7 


2.0 


Cervix Uteri 


379 


93.9 


3.2 


Corpus Uteri 


283 


99.6 


0.4 


Uterus, Nos 


35 


74.3 


25.7 


Ovary 


285 


90.9 


4.2 


Other Female Genitalia 


10 


90.0 


10.0 


Prostate 


1881 


95.8 


2.2 


Testis 


90 


96.7 


0.0 


Penis 


20 


100.0 


0.0 


Bladder 


415 


95.4 


2.4 


Kidney 


391 


89.0 


3.8 


Brain and Nervous System 


194 


84.5 


5.2 


Thyroid 


202 


97.5 


1.0 


Hodgkin's Disease (lymphoma) 


93 


96.8 


2.2 


Non-Hodgkin's Lymphoma 


506 


92.3 


4.3 


Multiple Myeloma 


158 


93.0 


5.1 


Leukemia 


414 


88.6 


8.5 


Total Cancers 


13,068 


91.4 


4.8 



30 



APPENDIX III 

International Classification of Diseases for Oncology (ICD-O) 
Categories Used to Classify Primary Site 



PRIMARY SITE CATEGORY 

Buccal cavity 

Esophagus 

Stomach 

Colon 

Rectum 

Liver 

Gallbladder 

Pancreas 

Peritoneum 

Nasal, sinus and ear 

Larynx 

Lung & bronchus 

Pleura 

Bone 

Soft tissue 

Melanoma 

Breast 

Cervix uteri 

Corpus uteri 

Uterus, NOS 

Ovary 



ICD-0 CODE 

140.0-149.9 

150.0-150.9 

151.0-151.9 

153.0-153.9,159.0 

154.0-154.8 

155.0-155.1 

156.0-156.9 

157.0-157.9 

158.0-158.9 

160.0-160.9 

161.0-161.9 

162.2-162.9 

163.0-163.9 

170.0-170.9 

171.0-171.9,164.1 

173.0 - 173.9 (M - 8721 - 8799) 

174.0-174.9,175.9 

180.0-180.9 

182.0-182.8 

179.9 

183.0 



31 



APPENDIX III - continued 



PRIMARY SITE CATEGORY 

Other female genital 

Prostate 

Testis 

Penis 

Bladder 

Kidney & urinary 

Brain & nervous system 

Thyroid 

Hodgkin's Disease (lymphoma) 

Non-Hodgkin's lymphoma 

Multiple myeloma 

Leukemia 



ICD-0 CODE 

1 83.2 - 1 83.9, 1 81 .9, 1 84.0, 1 84.8 - 1 84.9 

185.9 

186.0-186.9 

187.1 -187.4 

188.0-188.9 

189.0-189.9 

191.0-192.9 

193.9 

M - 965.0 - 966.9 

M - 9590 - 964.2, 967.0 - 971 .0, 975.0 - 975.9, 

M- 973.0 -973.9 

M- 980.0 -994.9, 995.1 






32 



APPENDIX IV 

Ninth Revision ICD Mortality Categories 
Used to Classify Primary Site 



PRIMARY SITE CATEGORY ICD-9 CODE 

Buccal cavity 1 40.0 - 1 49.9 

Esophagus 150.0-150.9 

Stomach 151.0-151.9 

Colon 153.0-153.9,159.0 

Rectum 154.0-154.1 

Liver 155.0-155.2 

Gallbladder 156.0-156.9 

Pancreas 157.0-157.9 

Peritoneum 158.0-158.9 

Nasal, sinus and ear 160.0-160.9 

Larynx 161.0-161.9 

Lung & bronchus 162.2 - 162.9 

Pleura 163.0-163.9 

Bone 170.0-170.9 

Soft tissue 171.0-171.9,164.1 

Melanoma 172.0-172.9 

Breast 174.0-175.9 

Cervix uteri 180.0-180.9 

Corpus uteri 1 82.0 - 1 82.9 

Ovary 183.0 

Other female genital 1 83.2 - 1 84.9, 1 81 .0 



33 



APPENDIX IV - continued 



PRIMARY SITE CATEGORY 

Prostate 

Testis 

Penis, other male organs 

Bladder 

Kidney & urinary 

Brain & central nervous system 

Thyroid 

Hodgkin's Disease (lymphoma) 

Non-Hodgkin's lymphoma 

Multiple myeloma 

Leukemia 



ICD-9 CODE 

185.0-185.9 

186.0-186.9 

187.1 -187.9 

188.0-188.9 

189.0-189.9 

191.0-192.9 

193.0-193.9 

201.0-201.9 

200.0 - 200.9, 202.0 - 202.2, 202.8 - 202.9 

203.0, 203.2-203.9 

202.4,203.1, 204.0-208.9. 



34 



APPENDIX V 

Table 1 . Population Estimates by Age, Race and Ethnicity Texas-Mexico Border Area, 1990- 
1992 1 . 



Males 

AGE 




5 
10 
15 
20 
25 
30 
35 
40 
45 
50 
55 
60 
65 
70 



4 

9 

14 

19 

24 

29 

34 

39 

44 

49 

54 

59 

64 

69 

74 



ANGLO 



75+ 



25733 
25770 
25638 
24435 
24699 
30488 
32929 
33094 
31430 
25166 
21899 
22040 
26927 
30865 
27731 
42923 



HISPANIC 



200130 

188348 

202159 

207718 

172828 

157415 

157349 

144449 

124314 

91109 

76188 

67955 

65943 

54141 

35720 

58818 



TOTAL 



- 


4 


27394 


207741 


235135 


5 - 


9 


28053 


195176 


223229 


10 - 


14 


27221 


207311 


234532 


15 - 


19 


27339 


213703 


241042 


20 - 


24 


31858 


163227 


195085 


25 - 


29 


32865 


143690 


176555 


30 - 


34 


33899 


137228 


171127 


35 - 


39 


33112 


121566 


154678 


40 - 


44 


33550 


104909 


138459 


45 - 


49 


26270 


76147 


102417 


50 - 


54 


22627 


60981 


83608 


55 - 


59 


22097 


52299 


74396 


60 - 


64 


24733 


49447 


74180 


65 - 


69 


26919 


43933 


70852 


70 - 


74 


25391 


27401 


52792 


75+ 




30978 


38260 


69238 


TOTAL 




454306 


1843016 


2297322 


Females 








AGE 


ANGLO 


HISPANIC 


TOTAL 



225863 

214118 

227797 

232153 

197527 

187903 

190278 

177543 

155744 

116275 

98087 

89995 

92870 

85006 

63451 

101741 



TOTAL 



451767 



2004584 



2456351 



'Population estimates used in calculation of incidence rates. 

35 



APPENDIX V 

Table 2. Population Estimates by Age, Race and Ethnicity Texas-Mexico Border Area, 1990- 
1993 1 . 



Males 

AGE 



ANGLO 



HISPANIC 



TOTAL 






_ 


4 


36145 


287550 


323695 


5 


- 


9 


36745 


259773 


296518 


10 


- 


14 


36093 


279226 


315319 


15 


- 


19 


36116 


288262 


324378 


20 


- 


24 


42412 


227163 


269575 


25 


- 


29 


42977 


194232 


237209 


30 


- 


34 


45127 


185440 


230567 


35 


- 


39 


44271 


165642 


209913 


40 


- 


44 


44688 


143471 


188159 


45 


- 


49 


35932 


105938 


141870 


50 


- 


54 


30393 


82995 


113388 


55 


- 


59 


29219 


70819 


100038 


60 


- 


64 


32509 


65947 


98456 


65 


- 


69 


35662 


59206 


94868 


70 


- 


74 


34353 


38394 


72747 




75+ 




42087 


51573 


93660 


TOTAL 




604729 


2505631 


3110360 


Females 








AGE 


ANGLO 


HISPANIC 


TOTAL 





. 


4 


34027 


277271 


311298 


5 


- 


9 


33815 


250439 


284254 


10 


- 


14 


33897 


272152 


306049 


15 


- 


19 


32154 


279708 


311862 


20 


- 


24 


32927 


238019 


270946 


25 


- 


29 


39495 


211719 


251214 


30 


- 


34 


43871 


211632 


255503 


35 


- 


39 


44168 


197045 


241213 


40 


- 


44 


42141 


170216 


212357 


45 


- 


49 


34380 


126521 


160901 


50 


- 


54 


29526 


103214 


132740 


55 


- 


59 


28979 


91916 


120895 


60 


- 


64 


35212 


88038 


123250 


65 


- 


69 


40967 


74113 


115080 


70 


- 


74 


37765 


49595 


87360 




75+ 




58143 


79560 


137703 


TOTAL 




601467 


2721158 


3322625 



Population estimates used in calculation of mortality rates. 

36 




Texas Cancer Registry 

Texas Department of Health 
1 1 oo W. 49th Street 
Austin, Texas 78756